68Ga-DOTANOC and 18F-DOPA PET/CT: a site-specific approach to the imaging of parangliomas of the head and neck and of the abdomen

Maximum intensity projection and transaxial 68Ga-DOTANOC (a–d) and 18F-DOPA (e–h) PET/CT images in a patient with SDHD mutation-related paragangliomas (PGL) and otherwise unexplained and uncontrolled hypertension are shown. Three PGL in the head and neck (HN) region (two at the right and one at the left carotid artery bifurcation) and two paratracheal PGL (b, c) are better appreciated on 68Ga-DOTANOC PET (left paratracheal 68Ga-DOTANOC SUVmax 9.9, 18F-DOPA SUVmax 2.7). An abdominal PGL (h) is better appreciated on 18F-DOPA PET (68Ga-DOTANOC SUVmax 5.9, 18F-DOPA SUVmax 20.0).

SDHD mutation-related PGL syndrome type 1 is a rare syndrome associated with a genetic predisposition to the development of multiple or single PGL, mostly in the HN region. The disease is inherited by a “parent-of-origin effect”; therefore, offspring are affected only if the disease is transmitted by the father.

Both 68Ga-DOTA peptides and 18F-DOPA have been successfully used for PGL imaging, with results superior to those with conventional procedures (CT, MRI) [1, 2, 3]. 68Ga-DOTANOC was found to be superior to 18F-DOPA in a retrospective series of 20 patients with extra-adrenal PGL, mostly HN PGL [3]. Moreover, 68Ga-DOTATATE was found to be the most sensitive tool for the detection of SDHD mutation-related HN PGL, due to their often smaller size and failure to concentrate sufficient 18F-FDOPA [4]. In a very recent meta-analysis the pooled detection rate of 68Ga-DOTA peptides was superior to that of all the other radiopharmaceuticals used [5]. Current EANM guidelines suggest that 18F-DOPA be used preferentially for abdominal PGL and 68Ga-DOTA peptides for HN PGL [1].

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